Laparoscopic versus open appendectomy in children: A retrospective comparative study of 2,332 cases

Esposito, Ciro, Borzi, Peter, Valla, Jean Stephane, Mekki, Monghi, Nouri, Abdelatif, Becmeur, Francois, Allal, Hossein, Settimi, Alessandro, Shier, Felix, Gonzales Sabin, MiguelAntonio and Mastroianni, Luciano (2007) Laparoscopic versus open appendectomy in children: A retrospective comparative study of 2,332 cases. World Journal of Surgery, 31 4: 750-755. doi:10.1007/s00268-006-0699-8

Author Esposito, Ciro
Borzi, Peter
Valla, Jean Stephane
Mekki, Monghi
Nouri, Abdelatif
Becmeur, Francois
Allal, Hossein
Settimi, Alessandro
Shier, Felix
Gonzales Sabin, MiguelAntonio
Mastroianni, Luciano
Title Laparoscopic versus open appendectomy in children: A retrospective comparative study of 2,332 cases
Journal name World Journal of Surgery   Check publisher's open access policy
ISSN 0364-2313
Publication date 2007-04-01
Year available 2007
Sub-type Article (original research)
DOI 10.1007/s00268-006-0699-8
Open Access Status Not Open Access
Volume 31
Issue 4
Start page 750
End page 755
Total pages 6
Place of publication New York, NY United States
Publisher Springer New York LLC
Language eng
Formatted abstract
Aim: The laparoscopic treatment of paediatric appendicitis remains controversial, especially in the presence of complications. This study evaluated the outcomes of open appendectomy (OA) and laparoscopic appendectomy (LA) by analysing the data from a multicentre study.

Methods: The authors retrospectively reviewed a series of 2,332 appendectomies (1,506 LA and 826 OA) performed in children and adolescents (median age 8 years) in 9 different centres of paediatric surgery. For the patients operated using laparoscopy, an IN procedure was employed in 921 (61.2%), an OUT procedure in 571 (37.9%) and a MIXED procedure in 14 (0.9%). In the open surgery, a McBurney incision was adopted in 795 patients (96.4%).

Results: Median duration of surgery was 40 minutes for LA and 45 minutes for OA. Median hospital stay was 3 days (LA) and 4.3 days (OA) in case of simple appendicitis and 5.2 days (LA) and 8.3 days (OA) in case of peritonitis. Complications were recorded in 124 LA cases (8.2%) and 65 OA cases (7.9%). The conversion rate in laparoscopy was only 1.6% (25 cases). The statistical analysis was performed using the Mann-Whitney test, and the main significant difference that emerged was the length of hospital stay, which was in favour of laparoscopy compared with open surgery (P < 0.0001).

Conclusions: We conclude that in clinical settings where laparoscopic surgical expertise and equipment are available and affordable, LA seems to be an effective and safe alternative to OA. Three out 9 centres participating in our survey perform LA in all patients with a suspicion of appendicitis. Our study shows that laparoscopy significantly reduces hospital stay in case of appendicitis and peritonitis and presents an extremely low conversion rate (1.6%) to open surgery. Laparoscopic transumbilical appendectomy (37.9%) in our series seems to be a simple option, even for less-skilled laparoscopic surgeons.
Keyword Randomized clinical trials
Complicated Appendicitis
Conventional Appendectomy
Perforated Appendicitis
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status Non-UQ

Document type: Journal Article
Sub-type: Article (original research)
Collection: School of Medicine Publications
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